Please be advised. In order to be considered as a candidate for the Upward Bound Program, the following information must be attached to the Application Packet upon submission. Failure to comply will result in denial of the application.

  •  UB Student Application
  •  Signed Waiver Form
  • Most Recent Report Card OR Recent Transcript
  • Counselor Recommendation
  • Math Teach Recommendation 
  • English Teacher Recommendation 
  • Tax Forms/ Income Verification Forms/ Government Assistance Forms/ Proof of Income
  • MEAP/MME/ M-step Scores to be provided by counselor
  • Student Personal essay **** It is preferred that you type the essay***

The one page or more, personal essay is an important part of the selection process. Please discuss ONE of the following topics: 1) What are some events, or who are some people, that have influenced you in your educational and professional aspirations? 2) What is your purpose in applying to the Upward Bound Program? What do you believe you will gain from this experience, and what contributions can you make to the program? 3) What is your most impressive accomplishment and how it has influenced you? ***Essay guidelines: Times New Roman font, size 12 font, and double-spaced ***

  Western Michigan University Office of Pre-College Programming Upward Bound Program 003E Walwood Hall Kalamazoo MI 49008-5288 Office: (269) 387-2723  Fax: (269) 387-3390

ELIGIBILITY CRITERIA

The WMU Upward Bound Program provides academic, financial, professional, and social support services to high school students to prepare them for college success. Applicants must meet the following requirements:  

  • Qualify under the U.S. Dept. of Education’s guidelines as a member of a low-income household or a household in which neither supporting parent holds a baccalaureate degree. 
  •  Meet U.S. residency requirements (citizen, permanent resident, applied for permanent resident) and be age 13- 19.
  • Demonstrate an academic need and the motivation to pursue college.
  • Be an incoming 9th, 10th, or 11th grader who attends or will attend one of the target senior high schools at time of entry:

• Kalamazoo Central     •Loy Norrix
Student Application
Student school ID *
Student First Name: *
Student Middle Name:
Student Last Name: *
Permanent Address; *
City; *
State: *
Zip Code: *
Home Phone:
Cell Phone Number: *
Student Email: *
Date of Birth: *
Gender: *
Social Security # *
Ethnic (Hispanic,1-Yes, 2-No)) *
American Indian/Alaskan Native (1-Yes, 2-No): *
Asian(1-Yes, 2-No); *
Black or African American (1-Yes, 2-No): *
Native Hawaiian or Other Pacific Islander (1-Yes, 2-No): *
White (1-Yes, 2-No): *
Citizen Status: *
High School Currently Attending or will Attend: *
Current Grade Level: *
School Counselor: *
Do you receive free/reduced lunch? *
Are you taking any ESL classes? if Yes what is your first language? *
Have you ever participated in: (check all that apply)
Talent Search
GEARUP
UBM/S
UB
Other:
With whom do you live with? (check all that apply)
Mother
Father
Other:
Does the Student require any accommodations (visual, audio, mobile,other)? if yes please explain *
Honors, Awards, Leadership Positions, Volunteering, Activities (list all you participate in) *
Discipline: Have you ever served detention, been suspended, or had other disciplinary issues? *
Parent Application
First Parent/Guardian Full Name: *
First Parent/Guardian 1 Relationship: *
First Parent/Guardian 1 Address: *
First Parent/Guardian 1 City: *
First Parent/Guardian 1 Zip Code: *
Contact 1 State: *
First Parent/Guardian 1 Cell Phone: *
First Parent/Guardian 1 Email Address: *
First Parent/Guardian 1 Work Phone:
Sources of Income: (please check all that apply) 
Employment
Unemployment
Social Security
TANF
TCA
Food Stamps
Disabilities
Child Support
Veteran's Benefits
Other:
Did First Parent/Guardian 1 file taxes last year? *
Taxable Income IRS Tax Form 1040: Line 43 or 1040A: line 27
Family Size: *
Signed 1040/1040A Prior Year Income Tax Return or government income statement i.e Social Security benefits, TANF, food stamps, Veterans Benefits, etc., or signed financial certification (NOT acceptable: W2 or pay stubs)
Does the First Parent/ Guardian 1 have a baccalaureate (4-yr) degree? *
First Parent/ Guardian 1 Highest Level of education *
Second Parent/ Guardian 2 Full Name: *
Second Parent/ Guardian 2 Relationship: *
Second Parent/ Guardian 2 Address: *
Second Parent/ Guardian 2 City: *
Contact 2 State: *
Second Parent/ Guardian 2 Zip: *
Second Parent/ Guardian 2 Cell Phone:
Second Parent/ Guardian 2 Email Address:
Second Parent/ Guardian 2 Work Phone:
Source of income if different from Guardian 1
Employment
Unemployment
Social Security
TCA
TANF
Food Stamps
Disabilities
Child Support
Veteran's Benefits
Other:
Did the Second Parent/ Guardian 2 file taxes last year? *
Taxable Income IRS Tax Form 1040: Line 43 or 1040A; line 27
Family Size: *
Upload Signed 1040/1040A Prior Year Income Tax Return (Pgs. 1&2) or Government income statement, i.e., Social Security benefits,TANF, food stamp, Veterans Benefits,etc.,or signed financial certification.(NOT acceptable: W2 or Pay stubs).
Does Second Parent/ Guardian 2 have a baccalaureate (4-yr) degree? *
Second Parent/ Guardian 2 Highest level of education: *

Certification: We, Parent and student, have completed this form truthfully and completely. We have provided accurate income and educational levels for all parents/guardians. If we provide false information, we will be forced to leave the UBK program. We allow the school permission to release academic information (transcripts, worksheets, test scores, attendance, behavior and report cards) to assess student progress. We will submit this information and a SSN/ Resident Alien No. and a signed copy of the 1040 Income tax form, before being accepted into the UBK Program.

If selected, we will attend a parent/student interview in which the student will complete a timed personal statement. If admitted into the UBK program we will follow all requirements, including attending Saturday/ after school tutorials during the academic year and commuting to a six-week summer program.
Parent Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.
Student Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.

Essay Guidelines

The one page or more, personal essay is an important part of the selection process. Please discuss ONE of the

following topics: 1) What are some events, or who are some people, that have influenced you in your educational and professional aspirations? 2) What is your purpose in applying to the Upward Bound Program? What do you believe you will gain from this experience, and what contributions can you make to the program? 3) What is your most impressive accomplishment and how it has influenced you? ***Essay guidelines: Times New Roman font, size 12 font, and double-spaced ***
Upload Student Essay Here!
Type Essay Here *
Program Waivers and Commitment

Transcript and Other Academic Records Waiver

I hereby authorize my child’s school(s) to provide WMU’s Kalamazoo Upward Bound Program, and Western Michigan University, access to copies of my child’s academic records for the duration of the program and through completion of his/her post-secondary education. I understand that these records will be kept confidential and will be used to follow my child’s educational progress or to determine when scholastic services are needed on his/her behalf.

Automated Voice Call Waiver

 I hereby authorize WMU’s Kalamazoo Upward Bound Program, and Western Michigan University to make automated calls or texts to my cell phone for program communication.

Program Commitment (Parent/Guardian)

I understand that by signing this document, I am authorizing the above-mentioned child to participate in authorize WMU’s Kalamazoo Upward Bound Program (UB), if selected. I understand my son/daughter is making a 2-year commitment to participate in all UB Program activities. My son/daughter will also complete the appropriate high school classes in preparation for enrollment to a four-year college or university. Before my child is accepted, I agree to submit my current year’s income form (attached). I understand that my child will not be considered for acceptance into the Upward Bound Program if I fail to submit all required documents and signatures (see above). I certify that all the information on this application is complete and accurate to the best of my knowledge.

Program Commitment (Student)

I understand that I am making a commitment to fully participate in all Upward Bound Program activities, complete program requirements, and to pursue the appropriate high school preparatory classes necessary for a four-year college or university
Parent Signature *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Student Signature *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Date: *